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TB or Not TB
TB or Not TB is a 2nd season episode of House which first aired on November 1, 2005. House treats a famous tuberculosis doctor who has diagnosed himself with TB. However, the constellation of symptoms convinces House there’s a more serious underlying condition. When it turns out the patient does have tuberculosis, his conscience forces him to refuse treatment for it and House has to convince him that tuberculosis isn’t the problem, but they will never known unless he agrees to be treated for it. Meanwhile, a comedy of errors occurs in the clinic when a patient who believes she has cancer is seen by Dr. Foreman wearing Dr. House’s name-tag in order to cover for House. When she demands an apology for the way “House” has treated her, it becomes clear to House and Foreman that the only reason Cuddy’s even considering demanding an apology is not because of Foreman’s behavior, but her perception that House always crosses the line. In the end, House finds a way to make it look like he has apologized to satisfy Cuddy. Recap After returning from Africa, the famous humanitarian and tuberculosis specialist Dr. Sebastian Charles collapses giving a speech to a pharmaceutical company. He is taken to Princeton-Plainsboro Teaching Hospital for treatment. Charles diagnoses himself with TB. However, House is not convinced and agrees to provide a “second opinion“. When House meets Charles, House acts in a typically insulting manner. House is opposed to having Charles sit in on the differential diagnosis. Charles takes over and outlines his own confirmation and treatment plan for TB. However, Charles refuses to take care of himself, constantly speaking to potential donors on his cell phone. House pages his team to come back in the absence of Charles to continue the differential. House thinks TB is not likely as it has progressed too quickly and the symptoms are too varied. Chase points out some variability in his heart rate and House orders a stress test to see if Charles' heart is causing his symptoms. Cameron tells Sebastian that House thinks it is sick sinus syndrome, and he will need a stress test and an echocardiogram. However, she does a PPT for tuberculosis anyway. House is clearly not impressed by Charles's humanitarian work, and attempts to convince Wilson, rather unsuccessfully, that Charles is driven by the same selfish human needs as everyone else. The echocardiogram and stress test are normal, so House suggests a stress test on a tilt table. He bets Foreman a week of clinic duty that this will show results, and Foreman eagerly accepts the bet. The tilt test goes smoothly until House literally cranks the machine to 11. The abnormal results appear to prove that Charles needs a pacemaker. He is scheduled for surgery. Charles is clearly taking a shine to Cameron and offers her both a job with him in Africa and a date. However, during an attempt to climb down the stairs with her, Charles vomits and collapses. Given the new symptoms, the diagnosis of the heart problem is clearly wrong. House orders an MRI. However, after the test is completed, the TB test shows positive. House is still not convinced TB is causing all the symptoms, but agrees to treat the TB. However, because Charles feels taking treatment himself while thousands of Africans can't afford the necessary drugs is somewhat hypocritical, he refuses treatment for the TB. House continues with the differential diagnosis. House then starts dissing Charles to the media (using Cuddy's name). He then goes to Lisa Cuddy to ask her to force Charles to agree to tests and treatment. However, Cuddy instead joins the media circus surrounding Charles. Meanwhile, Cameron attempts to get Charles to agree to palliative treatment. However, House decides if Charles wants to die of a third world disease, he should live without air conditioning, phones, television, running water and media attention. House turns off the air conditioning in the room and flushes the cell phone down the toilet. During the press conference, House watches it on TV in a coma patient's room and notices Charles is sweating instead of turning red (TB makes it nearly impossible for a patient to regulate their own temperature - he shouldn't be sweating at all). He goes to Charles' room and sees that Charles is going into cardiac arrest. House then turns to the TV camera and shouts "That is NOT TB!". "Compelling Television", Wilson says. House finally gets Charles to agree to be treated for TB as he points out that cardiac arrest while overheated is not a symptom of TB. He threatens to reveal the real cause of death after the inevitable autopsy. Charles points out that while he can accept failure, House cannot, and that is the difference between them. As the treatment for TB proceeds, Charles' symptoms decrease and the team focuses on the symptoms that remain to try to reach a new diagnosis. Focusing on Charles' occasional low blood sugar in his cerebro-spinal fluid, House decides it is a small insulin producing tumor. This would also explain the result of the tilt table test. However, such tumors are almost impossible to find. They decide to attempt to force the tumor to produce insulin, which would cause the patient's blood sugar to plummet, but would indicate its location. Finally, after Charles goes into a seizure during the procedure, the tumor indicates its presence. It is easily removed with surgery. Cameron decides not to date Charles, saying he will be in Africa most of the time. However, House thinks it is just another example of Cameron being attracted only to damaged men. Clinic Patients One patient has a headache, and House finds her sinuses are clogged as well. He diagnoses an allergy to her new cat. When the patient resists the drugs for the condition, he suggests using a bag and a river to take care of the cat. While Foreman fills in for House at clinic (wearing House's name badge), he meets a woman who thinks she has breast cancer. His initial examination makes it likely that the lump is benign, but the patient insists on a biopsy. The patient then complains to Cuddy about "Dr. House's" behavior. When Cuddy insists House apologize, House naturally can't admit it wasn't him (he was skipping clinic duty), but points out that the only reason that Cuddy is paying attention to the patient was because it was him - if the complaint was against Foreman, Cuddy would have ignored it. House asks Foreman to apologize, but Foreman also realizes it’s only an issue because Cuddy thinks it was House. House settles the matter by deliberately putting the tip of his cane on the patient's foot, then apologizes for being so clumsy in front of Cuddy. Since the patient thought House was just a cripple, she didn't see the cane incident as deliberate, proving House's point about perception. Major Events * After being forced to cover for House, Foreman meets a clinic patient named Cecila Carter who assumes that she has cancer. * Cameron develops a bond with Sebastian Charles who asks her to come to Africa with him but she refuses. Medical Errors When the PPD test on Charles shows positive Mantoux reaction he is brought pills by Cameron. He tosses them one by one naming them, refusing to take them. One of them is streptomycin. Streptomycin is used sometimes for TB but it belongs to the aminoglycoside group of antibiotics which are highly ionized and thus not absorbed enterically. Thus streptomycin is always given as IV or IM injection rather than orally as pills. Zebra Factor 10/10 Nesidioblastoma is a focal, non-malignant hypertrophy of pancreatic beta-cells, distinct from both an insulinoma (malignant tumour of pancreatic beta-cells), and nesidioblastosis (diffuse, non-malignant hypertrophy of pancreatic beta-cells). By this definition, the first case report of a nesidioblastoma in the adult literature occurred in 2010 (http://www.humanpathol.com/article/S0046-8177(09)00330-X/abstract), some five years after this episode was aired (at the time the existence of this condition was merely theorised). Title The title of the episode is a reference to the famous soliloquy: "To be, or not to be" from Hamlet written by William Shakepeare. In this case, it refers to the medical pulminary disease tuberculosis, translating in full to be 'Tuberculosis or Not Tuberculosis.' Trivia & Cultural References *The Nobel Peace Prize, unlike other Nobel Prizes, is awarded in Oslo, Norway, not Stockholm, Sweden. The Nobel Prize for Medicine is awarded for a medical breakthrough, not for saving life per se. *Hershey, Pennsylvania is an unincorporated town in Derry Township, Pennsylvania that is the headquarters of the Hershey Chocolate company. Its name was changed to match the company in 1906. *When Foreman is doing a tilt table test, House turns it up to get a better result, and asks "Does this go up to 11?" This is a reference to the movie "This Is Spinal Tap". Cast * Hugh Laurie as Gregory House * Lisa Edelstein as Lisa Cuddy * Omar Epps as Eric Foreman * Robert Sean Leonard as James Wilson * Jennifer Morrison as Allison Cameron * Jesse Spencer as Robert Chase * Ron Livingston as Sebastian Charles * Andrea Bendewald as Cecilia Carter * Ken Weiler as Jerry * Mary Wickliffe as Mandy * Hansford Prince as Bogale * Joram Moreka as Father * Harry F. Brockington IV as Dahoma de:Mehr Sein als Schein Category:Season 2 Category:Episodes Category:Zebra Factor 6